Benign Paroxysnal Positional Vertigo Flashcards
What is benign paroxysmal positional vertigo (BPPV)?
BPPV is one of the most common causes of vertigo, characterised by sudden dizziness triggered by changes in head position.
What is the average age of onset for BPPV?
The average age of onset is 55 years, and it is less common in younger patients.
What triggers vertigo in BPPV?
Vertigo is triggered by changes in head position, such as rolling over in bed or gazing upwards.
What are common features of BPPV?
Features include vertigo triggered by head position changes, possible nausea, episodes lasting 10-20 seconds, a positive Dix-Hallpike manoeuvre, and rotatory nystagmus.
What is the Dix-Hallpike manoeuvre?
The Dix-Hallpike manoeuvre involves rapidly lowering the patient to the supine position with an extended neck, recreating the symptoms of BPPV.
What is the prognosis for BPPV?
BPPV has a good prognosis and usually resolves spontaneously after a few weeks to months.
What treatments are available for BPPV?
Symptomatic relief may be gained by the Epley manoeuvre (successful in around 80% of cases) and vestibular rehabilitation exercises like Brandt-Daroff exercises.
What medication is often prescribed for BPPV?
Medication such as Betahistine is often prescribed, but it tends to be of limited value.
What is the recurrence rate of BPPV symptoms?
Around half of people with BPPV will have a recurrence of symptoms 3-5 years after their diagnosis.
Definition
Benign Paroxysmal Positional Vertigo (BPPV) is a medical condition characterised by sudden, episodic attacks of vertigo induced by changes in head position. This condition is due to detachment of otoliths in the inner ear, which results in hair cell stimulation and subsequent vertigo symptoms.
Epidemiology
BPPV is the leading cause of vertigo and is especially prevalent within the elderly population. This increased prevalence is largely attributed to the accumulation of calcium deposits, known as cholelithiasis, within the semicircular canals of the inner ear.
Aetiology
BPPV arises due to a detachment of otoliths from the utricle of the inner ear. These detached particles can migrate into the semicircular canals, where they stimulate hair cells and lead to symptoms of vertigo.
Signs and Symptoms
Key clinical features of BPPV include:
- Vertigo attacks provoked by specific head movements, such as turning the head to one side while in bed or looking upwards
- Episodes of rotational vertigo lasting between 30 seconds to 1 minute
- Absence of auditory symptoms
- Recurrent episodes, often resolving naturally over weeks to months
Differential Diagnosis
Differential diagnoses for BPPV include other conditions that can cause vertigo such as:
1. Meniere’s disease: Episodic vertigo, tinnitus, hearing loss, and a sensation of fullness in the ear.
2. Vestibular neuritis: Sudden onset of severe vertigo, nausea, and imbalance lasting for several days.
3. Labyrinthitis: Vertigo, hearing loss, and tinnitus.
Investigations
The primary diagnostic test for BPPV is the Dix-Hallpike manoeuvre. This test involves a series of specific head movements that provoke the characteristic vertigo and nystagmus associated with BPPV.
